Strabismus

Last Updated August 2021 | This article was created by familydoctor.org editorial staff and reviewed by Robert "Chuck" Rich, Jr., MD, FAAFP

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What is strabismus?

Strabismus is an eye disorder. It affects the muscle control in your eyes. The eyes don’t line up properly. Instead, the eyes appear to cross, or one eye may wander to the side. One eye’s vision becomes weaker. This disorder also is called “crossed eyes.” If it is not fixed when a child is young, their brain will always ignore what it sees from the weak eye.

Symptoms of strabismus

You may notice your child closes one eye to see with the other. You also may see your child turn their head to one side to see. Other symptoms can include:

  • Crossed eyes
  • Wandering eyes
  • Eyes that don’t point in the same direction
  • Loss of vision or depth perception

People who develop strabismus as adults are likely to have double vision. That’s because their brain has learned how to read images from both eyes. Then, when strabismus is diagnosed, the brain still sees images from both eyes, even though the eyes are looking at different things. Hence the double vision.

Symptoms may be present all the time or may come and go. It’s normal for newborn babies to have eyes that cross or wander. It happens more when they are tired. If your child is older than 3 months of age, tell your doctor if you see notice these symptoms.

What causes strabismus?

There are six muscles around each eye. When these muscles don’t work together, each eye sees different things. This confuses the brain. The brain learns to focus on the image from the stronger eye.

In most children with strabismus, the cause is unknown. More than half the time, the problem is present at or shortly after birth. This is called congenital strabismus.

Conditions occasionally associated with strabismus in children include:

Strabismus that develops in adults can be caused by:

  • Botulism
  • Diabetes
  • Graves’ disease
  • Guillain-Barré syndrome
  • Injury to the eye
  • Shellfish poisoning
  • Stroke
  • Traumatic brain injury
  • Vision loss from any eye disease or injury

A family history of strabismus is a risk factor. Farsightedness may be a contributing factor in children.

How is strabismus diagnosed?

Your doctor will talk with you about your symptoms and do a physical exam. This will include checking your eyes through various eye tests.

Can strabismus be prevented or avoided?

This disorder cannot be prevented or avoided.

Strabismus treatment

Treatment is important. If not treated, the weaker eye will never see well. Treatment can help your child have normal vision. The earlier the treatment starts, the better.

Treatment focuses on making the weak or wandering eye stronger. This could involve wearing a corrective glasses or an eye patch. Putting eye drops in the “good” eye can make the weak eye stronger. Treatment can temporarily affect vision in both eyes.

Some children need surgery. It is usually not recommended until after other treatments have been tried. Surgery is simple, but it doesn’t always make the eyes perfectly straight. Sometimes surgery has to be repeated later.

Treatment for strabismus may go on for months or even a few years. Your child may have to wear their eye patch less over time. The same is true for eye drops.

Living with strabismus

Your doctor may recommend your child does eye exercises. These can help the eyes focus on the same spot.

About one-third of children with strabismus will develop amblyopia. This is a lazy eye. If amblyopia is not treated by about age 11, it is likely to be permanent. That’s why early treatment is so important.

If your child has surgery, know that vision problems may remain after surgery. Your child may still have reading problems. Vision may affect the ability to play sports. Adults may have a hard time driving.

Questions to ask your doctor

  • Are there certain eye exercises my child can do that will help?
  • How many hours a day does my child need to wear an eye patch?
  • Does this condition cause kids or adults to become dizzy?
  • If one of my children has strabismus, are my other children at higher risk?
  • If treatment is successful, will my child have vision problems later in life?